Stewardship.Gen(PPP)

Stewardship.Gen(PPP) - Optimizing Antibiotic Use A...

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Click to edit Master subtitle style 9/14/11 Optimizing Antibiotic Use A Practical Approach to Antimicrobial George Sakoulas, MD UCSD School of Medicine
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9/14/11 Objectives Understand the balance of antibiotic prescribing Consequences of overprescribing antibiotics Strategies for judicious antibiotic use to reduce the rate of resistance
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9/14/11 Some Points to Consider The antibiotic era is 4.5 billion years old Resistance to antibiotics exists in nature before medicine actually discovers or uses them Unlike any other class of medication, antibiotics treat not only the individual, but have impacts on society
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9/14/11 Antimicrobial Treatment Considerations Must be timely: delay in initiation potentially lethal Appropriate: must cover the offending pathogen(s) Administered at adequate dose and intervals consistent with pK/pD parameters Timely streamlining based on Deresinski S. Clin Infect Dis 2007; 45:S177- S183
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9/14/11
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9/14/11 Adapted from Kollef MH et al. Chest. 1999;115:462-474. ATS/IDSA. Am J Respir Crit Care Med . 2005;171:388-416. “…selection of initial appropriate antibiotic therapy (ie, getting the antibiotic treatment right the first time) is an important aspect of care for hospitalized patients with serious infections.” ATS/IDSA Guidelines A Study by Kollef and Colleagues Evaluating the Impact of Inadequate Antimicrobial Therapy on Mortality Inadequate antimicrobial treatment (n=169) Adequate antimicrobial treatment (n=486) 0 All-Cause Mortality Infection-Related Mortality 24 42 * 18 Hospital Mortality (%) 52 * * P <.001 Importance of Initial, Appropriate Antibiotic Therapy ATS=American Thoracic Society; IDSA=Infectious Diseases Society of America.
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9/14/11
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9/14/11
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9/14/11
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9/14/11
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9/14/11 Novel Antibiotic Development
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9/14/11 Discovery of New Antibiotic Classes
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9/14/11
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9/14/11
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9/14/11 ESKAPE and Mortality in Bacteremia VRE (n=683) vs VSE (n=931) OR 2.52 (1.9-3.4) Ref 1 MRSA (n=382) vs MSSA (n=433) 11.8% vs 5.1% (p< 0.001) Ref 2 Klebsiella pneumoniae 52% vs. 29% (p=0.007) Ref 3 ESBL (n=48) vs non-ESBL (n=99) Acinetobacter baumanii 58% vs. 28% (p< 0.05) Ref 4 Imipenam R (n=40) vs S (n=40)
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This note was uploaded on 09/14/2011 for the course PHARM pp taught by Professor Staff during the Spring '11 term at UCSD.

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Stewardship.Gen(PPP) - Optimizing Antibiotic Use A...

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